[Victims of violence: importance of medical testimony for the practitioner]. / Victimes de violences: L'importance du constat médical pour le praticien.

Physicians may be asked to provide care to victims of violence. Adequate diagnostic and therapeutic management must be provided. Establishing a detailed medical testimony can substantially influence the judiciary or administrative procedure's outcome. This paper provides guidelines for writing a medical testimony and describes the criteria that physicians need to consider in order to serve at best the interests of their patient within a mutually trustful relationship.

[The health of asylum seekers: from communicable disease screening to post-traumatic disorders]. / La santé des demandeurs d'asile: du dépistage des maladies transmissibles à celui des séquelles post-traumatiques.

As the end of this century approaches, the pressure of migration is increasing. It is difficult to limit with restrictive measures the number of refugees and persons seeking asylum in Europe in each country, medical screening programs are organised for arriving refugees and asylum seekers. In Switzerland, they are screened for tuberculosis and hepatitis B. They are offered standard vaccinations and immunized for hepatitis B according to screening results. The prevalence of tuberculosis in asylum seekers is 414 per 100,000, 227 per 100,000 of bacteriologically active tuberculosis. Anti-HBc antibody is present in 22% of women and 39% of men. The frequency increases with age and varies greatly according to origin. Initially, refugees were screened for intestinal parasites. Over a quarter were carriers, a large majority asymptomatic. Increasing numbers of asylum seekers come from countries affected by war and insecurity. Systematic screening carried out in Geneva for previous exposure to violence revealed that 61% reported major trauma, 18% reported torture and 37% complained of symptoms such as nightmares, insomnia, flashbacks, etc. The authors discuss issues related to medical screening programs, and their relative usefulness in an increasingly mobile world where the distinction between travellers and migrants is not always clear.

[Identification of victims of violence and torture: the practitioner's role]. / Identifier les victimes de violences et de torture: le rôle du praticien.

Many asylum seekers and refugees arriving in Switzerland have been exposed to major trauma such as war, incarceration or torture. A growing number of Swiss doctors treat patients who are victims of violence and torture, and may need to draw up medical reports on sequelae of such trauma. These are often difficult to detect, as patients do not bring up the subject spontaneously. A request for a medical report offers an opportunity to recognize and explore the patient's past traumatic experiences and can be a first step in the therapeutic process. The experience gained in this field at the Travel and Migration Medicine Unit, Geneva, is reported in this article. Analysis of 82 cases treated between June 1991 and December 1993 documents the types of trauma alleged and illustrates the patients' complaints and the clinical signs observed.

Serum TNF in patients with severe malaria treated by exchange transfusion.

The authors report on three cases of severe P. falciparum malaria successfully treated by iv quinine and exchange transfusion. Serum concentrations of Tumor Necrosis Factor (TNF) were determined before and during treatment. After an initial decrease, serum levels of TNF remained markedly elevated during the first 48 hours despite exchange transfusion. Though exchange transfusion accelerates the elimination of parasites from the blood, it seems to have no immediate effects on reducing serum levels of cytokines such as TNF.